Five Potent Tools for Tennis Elbow

What do you do for patients with chronic tennis elbow? Most evidence-based chiropractors have a multimodal recipe that includes manipulation, manual therapy, anti-inflammatory modalities, and stretching. Today’s blog will describe 5 proven ingredients to help improve your clinical recipe for this stubborn diagnosis.

Watch Dr. Steele will cover the five must do’s for Tennis Elbow.

The first and most critical step in managing chronic tendon problems is to decide if this is a real “itis” (acute), or an “opathy” (chronic). Refer to THIS past blog on making the differentiation between the two. Let’s review the research behind the latest recommendations for lateral epicondylopathy.

Eccentric Exercises

Eccentric strengthening is thought to stimulate collagen metabolism and synthesis in the rehabilitation of tendinopathies. Wrist eccentric control exercises can be useful for relief from pain due to lateral epicondyopathy and for the improvement of functions impaired by tennis elbow. (1)

Additionally, “A systematic review was undertaken to identify randomized and controlled clinical trials incorporating eccentric exercise as a treatment for patients diagnosed with lateral epicondylitis. Eight of the twelve studies were randomized trials investigating a total of 334 subjects. The majority of consistent findings support the inclusion of eccentric exercise as part of a multimodal therapy program for improved outcomes in patients with lateral epicondylitis.” (2)

Wrist & Elbow Orthoses

The use of a counter-force strap applied firmly approximately 10 cm distal to the elbow joint has been shown to decrease pain and improve grip strength. Counter-force braces should not be used in cases of concurrent radial tunnel syndrome, as the additional pressure will likely exacerbate compressive neuropathy symptoms. Use of wrist-extensor splints has also demonstrated positive results. (3) Be careful with the long-term use of orthoses as they may lead to increased activity in upper trapezius, lower trapezius, serratus anterior, and anterior deltoid as these muscles must compensate for that lack of mobility in the wrist. (4)

Extracorporeal Shockwave Therapy (ESWT)

In the past decade, shockwave therapy had emerged as a leading choice for many orthopedic disorders including lateral epicondylopathy. (5-8) ESWT was found to yield significant clinical improvement. (5-8). ESWT units are expensive, however, may add substantial benefit to patients suffering from chronic symptoms. (3)

Taping

Tennis elbow patients are looking for symptomatic relief NOW. Elastic therapeutic tape may help. In one study, taping produced significant effects on pain relief and pain-free grip strength for patients with lateral epicondylitis, and seemed to have additional effects on controlling pain that was elicited by resisted wrist extension. (9)

Shoulder Rehab

Don’t forget about the shoulder when treating tennis elbow! Wrist eccentric control exercises and shoulder stabilization exercises can be useful for lateral epicondylopathy and for the improvement of functions impaired by tennis elbow. Shoulder stabilization exercises in a closed chain (hand stabilized on a wall or floor) are valuable therapeutic exercises for the upper extremities (10)

Here are two popular shoulder stabilization exercises you can use tomorrow:

A survey of ten chiropractic treatment protocols for tennis elbow would most likely reveal ten different strategies. As illustrated by two recent papers, this discrepancy is no different from other healthcare professions. Bateman et al. found physical therapists used varying recipes for managing tennis elbow:

“there was no consistency in the choice of modality used, the type of exercise or the dose of exercise prescribed. The use of passive modalities and corticosteroid injections was found to remain commonplace, despite a lack of supporting research evidence. There is a clear need for evidence-based guidelines for physiotherapists treating patients with tennis elbow.” (11)

Not only is there a lack of consensus among physical therapists in the treatment of lateral epicondylitis; there is considerable individual variation among orthopedic surgeons.

Applying best practice evaluation and treatment is not commonplace. It takes years for new treatment strategies to transfer from research to clinical practice. Clinicians often rely on outdated information to guide their decision-making process. Delays in knowledge transfer result in a wide variation in treatment approaches. Evidence-based chiropractors have made it their mission to apply the right treatment to the right patient at the right time. Knowing how to apply the best procedures and evaluations per condition is dependent on the knowledge of peer groups, colleagues, seminars, personal research, and continuing education. Our friends at FAKTR provide excellent training for many of the latest tendinopathy strategies.

Changing your treatment recipe impacts your time, patient responsibilities, and staff utilization. However, small modifications to clinical care can add substantial benefit to patient recovery rates and satisfaction. ChiroUp.com has already incorporated these up-to-date “best practice” recommendations into your clinical protocol and patient education. We will continue to work hard to provide you with the most useful information for patient-centric care.

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About the Author

Dr. Brandon Steele

DC, DACO

Dr. Steele began his career at The Central Institute for Human Performance. Dr. Steele has trained with experts including Pavel Kolar, Stuart McGill, Brett Winchester, and Clayton Skaggs. He has been certified in Motion Palpation, DNS, ART, and McKenzie Therapy. Dr. Steele lectures extensively on clinical excellence and evidence-based musculoskeletal management. He currently practices in Swansea, IL and serves on the executive board of the ICS.